Pretest probability assessment for selective rest sestamibi scans in stable chest pain patients

Am J Emerg Med. 2000 Nov;18(7):789-92. doi: 10.1053/ajem.2000.18030.

Abstract

The objective of this study was to determine whether pretest probability assessments permit more selective testing of chest pain patients with technetium-99m sestamibi scanning. Pretest probabilities of cardiac ischemia were measured both objectively (Acute Cardiac Ischemia Time-Insensitive Predictive Instrument [ACI-TIPI]) and subjectively (physician's estimate of the probability of unstable angina). Two groups were defined: patients whose postsestamibi scan led to a "downgrade" of the intensity of monitoring and those that resulted in no change in monitoring intensity. Sixty-five patients met study criteria; 25 had a disposition downgrade and 40 had no change. Pretest ACI-TIPI scores were similar in the two groups (29% +/- 18% versus 27% +/- 11%, mean +/- standard deviation; P = .95) as were the physician's assessment of unstable angina (39% +/- 22% versus 40% +/- 24%; P = .75). Objective or subjective pretest probabilities are not significantly different in patients who are likely to have their disposition altered by sestamibi scanning.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chest Pain / diagnostic imaging*
  • Cost-Benefit Analysis
  • Emergency Service, Hospital*
  • Female
  • Heart / diagnostic imaging*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Ischemia / diagnostic imaging
  • Patient Selection
  • Predictive Value of Tests
  • Radionuclide Imaging
  • Radiopharmaceuticals*
  • Technetium Tc 99m Sestamibi*
  • Triage

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi